Permit ! 4 CITY OF TIGARD MASTER PERMIT
t3 • COMMUNITY DEVELOPMENT Permit #: MST2012 -00217
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 2S102DC06400
Jurisdiction: TIGARD
Site address: 13878 SW 90TH AVE
Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 13
Project: Gertz Homes at Edgewood No. 2, Lot 13
Project Description: New SF. DEMO CREDITS FROM BUP2011 -00156 APPLIED TO THIS PERMIT.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1678 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1099 sf Garage: 421 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2777 sf Value: $312,407.60 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fumy =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 5 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +ampNolt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecom asin Y
Other: N Other Description: P 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R - 3 2777
Owner: Contractor:
GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions)
19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 - 4175
TUALATIN, OR 97082 TUALATIN, OR 97062
PHONE: 503 -692 -3390 PHONE: 503 -692 -3390
FAX: 503 -692 -5433
Total Fees: $8,397.90
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don ' nce with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da . ATTENTION: on law requires you to follow the rules adopted by the Oregon Utility Notification, Center. Those rules are set forth in OAR
2- 001 -0010 through OAR • -• • -0. • I. Yo ay obtain a copy of the rules or direct questions to OUNC b • • 50 .• 32.1987 or 1.800.332.2344.
f
sued By: '.1: —. !d ' i.,�(-4-- Permittee Signatur '' �' ' .:fl�� !y
Call 503.639.4175 by 7:00 a.m. for the next available Inspection • .
Thi- • ernit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Building Permit Application
' Iesidential 1ZI::EI\'1I: . lOR oFI•i(:I•; tst: oi'
of Tigard Received : 131 IvdTigard, OR 972'3 AUG 16 2012 Permit No.: Review
. . : Phone:503.718.2439 Fax: Date/B : otiierPermt:. ,, ,j_
IIGRD Inspection Line: 503.639.4175 niur iinni' DateReady/By: juri SeePage2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notifie/Method: Supplemental Informajoo
.:
New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
O Addition/alteration/replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
i'; I .. work indicated on this application
❑ 1- and 2-family dwelling ❑ Coniinercial[mdustrial Valuation: S
❑ Accessory building ❑ Multi-family Number of bedrooms: -
❑ Master builder ❑ Other: Number of bathrooms: -
!" Total number of floors:
Job site address: / 3 8 7j' S YQ New dwelling area: Csquare feet'77
City/State/ZIP: Tigard OR 97224 4.C.. f? 2> '/ Garage/carport area: square feet
SuiteibldgJapt. no.: Project name: Covered porch area: 3 (, square feet tl.9cl
Cross stieetJdirections to job site: Deck area: square feet )
A Other structure area: 3 ( square feet 24-
QUAT
- Subdivision: Lot noQ9( Permit fees are based on the value of the work performed.
/ Indicate the value (rounded to the nearest dollar) of all
axTax map/parcel no.: 2 ,5/ �ddOC. 6 C I' . equipment, materials, labor, overhead, and the profit for the Ml; work indicated on this application
Valuation: S
- Existing building area: square feet
New building area:. square feet.
Number of stones•
Name: - Type of construction:
Address: . Oc groups:
City/State/ZIP: - 7. . tfl.. 72 Existing:
$
Phone: (5 ) (q . —p 'C) Fax: ( 3) 6 ?-s . New:
. ,- rcr i
- .
Business name: t ' plan review fee (or deposit):
Address: /'? 7 -f4-i # ' FLS plan review fee (If applicable):
'
- Total fees due upon app li ca tion
City / State/ZIP: . & ttoar . 7
Phone: (5) Fax: : , . Amount rece r (JQ .
E-mail: .. .... ................. ,.... .
--• .... COflUflCTC1al and residential prescrip. - .. in stallation of
,I.1i1.:�;: ,:: •,:.:�:,�•:: ; : �:�.;?i�: _ ( ' -'J ( - roof top mo Photovoltaic So Panel System
O B m • Submit two (2) of roof plan th connection details
us ass name. '.' and fire deparun... al. g with the 2010 Oregon
Address: / 2-o C:) " Solar Installations' . alty 'ode checklist.
(%s City/State/ZIP: 1C/L ) 2_- $180.00 and Phone: (3) Fax: (J?3) 2- j .7 2 State surcharge (1 a of perms -.): $21.60
CCB tic.: CS 3 •Z) Total fee due upon application: $201.60
Authorized signature: Tb pennit application expire, if a permit I. not obtained
withIn 180 days after It has been accepted as complete.
PTifl?t Date: * Fee methodology set by Th-County Building Industry Service Board.
l:\BuildingPennitsBUP-REspermitApp.doc 02/24/2011 440.4613T( I 1/02/COM/WEB)
imbinz Permit Application .
tilling Fixtures .
City of Tigar Received
r t 6 ' 7 At PermitN°:�'le'J1 1�. -0611
• 13125 SW Hell Blvd., Tigard, OR 972 1 6 20�2 I 1 ` �j
r Plan Raviow �►�'��11 1 ,
■ Phone: 503.718.2439 Fax 503.598. � � D a y . Other Permit No.:50)�
it i_.) Inspection Line: 503.639.4175 OF � Da Ready/ Jun i: ® s ee Page 2 for
Internet www.tigard - or.gov CITY F iV� . Notified/Method: S . • • medal Informatloo •
-7 +sx
"9 y ,qr . Xi , Vg Y :;': - ' w ,it '':: _ • ' .nom ' •f�., r r. `;z'�5,
zt- _ .: ? s : , I 9L rr " , r : `S - i i . „; rt�; . 7 I.: ,
ew construction x : ❑ Demolition For special information use chemist
_ Description 1 Qty. 1 Es. 1 Total
ddition/alteration/replacement ❑Other New I- 2- family dwellings (includes 100 ft for each utility connection)
d.,p it': - ;; . --; ,
. c ....".7 f: z "'z-4:::'` SFR (l) bath 312.70
�t.:2tiom � w
,.:? ii _ r. _ _ 5r°Y ,.. •
dustrial SFR (2) bath - - 437.78
- and 2- family dwelling CoanmerciaUln
❑ SFR (3) bath t 500.32
,ccessory building ❑ Multi- family
�q
Each additional bath/kitchen 25.02
taster builder ❑ Other: Fire sprinkler ( sq. It) Page 2
• '
? ,. : ', L'! I; " . . • ` � . ,. , .9't (e• , f „ +'ti: ; :_ h : ' ` '' '' zip(.' Site utilities:
' ,, Catch basin or area drain • . 18. •
Ate address: 13 $ 7 r S � Q 7 � .
n �1 Drywall, leach line, or trench drain • 18.
JState/ZIP. T• fv>vrL� O" Footing drain (no. linear R: Paget
• tf
Aids/apt. no.: 1/ Project name:
Manufactured home utilities 50.03
9s street/directions to job site: Clife 4yatry -e• .i e B z4 18.76 Manholes 18.76 .
Rain drain connector
Sanitary sewer (no. linear ft.: -_) Page 2
Stone sewer (no. linear ft.: � Page 2
Water service (no. linear ft.: _) Page 2
division: E os w e a r p _Zr-- Lot no.: L 3 Fixture or item:
map/parcel no.: 2' Sy OZ. � C oG yd
Backflow preventer 31.27
c.: ��. a- , :,S. -:,,. :, _ . - , '.k;..i: `t iii;•z ,,•- , ,kt,y• , :: Backwater valve . 12.51
, � . ;;_ -; r � , / 1 .::.�. ' .. J M _ r. M r Clothes washer 25.02 .
- -e4‘.1 f'tGNit. Dishwasher 2 5.E
• . Drinking fountain 25.02
Ejectors/stune 25.02
W a 1.w, r •• t a % , 7j1 ' , r I a ' yti 'a"R5 * t e
Expansion tank 12.51
ua;, . ';':;.1 .715:: a ' Fiature/sewercap 25.02
II0 c - a 1 �' G /04.4., Floor drain/floor sink/hu 25.02
dress: 1 ! Z b a T4..) qG 'A • Garbage disposal 25.02 .
y /State/ZIP: t(i , lfril d 2 9)O 4 2 - Hose bib • 25.02
,ne: (Sti 3 )412-33 fb Fax: (6407 -543 Ice maker 12.51
r . , ;.7 "-: ' ::•,,, 25.02
, „. ,..7. �rM,- ,.lt,�e�'�'r�ttf 7•,; 7 4;,��;; ^' ; •ti M1 . , ln� trap ] Fz Medical gas (value: S ) Page 2 .
:smma Home: twez d d vs'E -- d 1....e._ 12.31 • :
Primer •
t name: /6,�i G ... 2___ Roof drain (commercial) 12.51 . . .
sae: / 2. a a CO &VG 44 Sink/basin/lavatory [ 25.02
y /State/ZIP: 4. (ILid y OA 7) d G L- Solar units (potable water) 62.54
one: 603) 492 - 3 ,3 Fax: : (503) 4 g 2Z - $1" 3 3 Tub/shower /shower pan • 12.51
Urinal 25
.nail: <,p rtfsG o , eo r+ water closet 25.02
.�..,, .' >rr >,rv+► c• '41?'r- .:•ri`•ti:•:--.' --rTap`,:+
..e - u .,, t r ' T . _ ? ;. . .. . ^.,., h - .4'l s. •,'> 7 , 37.52•
r ` , M f., / :: ` -.,i1 ,
w ater heater
sinew name: f � � ...,. A 4- O U 4., i v Water piping/DWV 56.29
idrese: P 0 !� 0 s . 2 7 Other
�! V r. 25.02
ity /State/ZIP: 4,4.,) es f 4 ;Army D 1 Dk _ Subtotal
MCC ( 543) 7 3' g S Fax: (S d 3,)G,i- 3 2! Z Minimum permit fee 572.50
Plan review (25% of permit fee)
CB Lic.: 1 03 712- Phmmbing Lie. no.: 7.211 /4 • state susedaAe(1296 of permit fee) _
uthorized.sigaatl>re: ' TOTAL PERMIT FEE
� j/ I . " eaptemeadelmem Nb eseaemmlaa k milYie 1US dqe►
r This pima spplisssim 'rim name: ..r.. -- Data 3'l!T /L
•Ps.. -. eiem r serby Tri-Coa er Baildloslodma7 See"ac.Bomed.
Io/01109 - 440.4m167it01atICOMMISS) • --
a6V aupp1emental Information
■
Fee Schedule:
;. = Y, - =,N= a , Residential F'
te: .. : �s. �., ors- : ����-� . Su . ress><on S stems:
• Footing drai {� _ i�L ~ � + a J
50. 0 to 2,000 i u -. P ;t.r3 ` �aF ;
Footing drain .each addidgna 100' 37 512190
Sewe 1st I00' 2,001 to 3,600 , ,
62.54 3,601 to 7,200 5233.20
Sewer -each additiona 100' 37.52 1,201 and -.
IHRE
Water Service - 1st 100' 6254
Water service -each additional !oo' Medical Gas S stems:
37.52 �
Stone &Rain Drain -1st 100' 6254 t --, �r a,
Storm Bt Rain Drain .. 51.00 to $5,000.00
each
additi 3 7.52 Minimum fee S72.50 7..-:.',',',:-.:-•::-;•,:-
$5,001.00 to $10,000.00
y1 lnsperxion of e .7"1 lamb $72.50 for the first $5,0 and 51.52 for
:.,:_r. .
: each additional S100.00 or Ot fraction thereof to thereo
g P ing or for and includin_ $10,000.00.
which no fee is specifically indicated 90 OO/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
( minimum charge -1/2 hour each additional $100.00 or ereo
Inspections outside of normal business 90.00/hr and includin: $25,000.00. fraction � � to hours (minimum charge - 2 hours ) $25,001.00 to $50,000.00
$379.50 for the first $25,000.00 and $1.45 for
Reinspection Fees 90.00/hr each additional S100.00 or fraction thereof to
Additional plan revi for revisions and includin: $50,000.00.
minimum 0 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
minimum -1R hour
Subtotal: each additional $100.00 or fraction thereof
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes",
please indicate work perforated by fixture. Failure to
accurate report fixtures could result in increased sewer fees *. •
F13toreirype fork . _ 0 1?i1<tpre , . :: ,• ;a ` .m � 9� mat ' ti ,
: VKoekF.adbCmedr Capwd. *a °° • � r unt :. Plan review is required for any of the following,
B ora /Font
Bath Please check all that apply.
- Tub/Shower ❑ Any new commercial building with
- lecual/Whiri • „ I B water service 2" and
Car Wash - Each Stall greater, except systems designed and stamped by licensed
- Drive Thru
engineer.
Cus idor/Water qs iraror ❑ New exterior plumbing site utilities for any complex structure
Dishwasher - Commercial as defined in OAR918- 780-0040,
.p ❑ Medical gas and vacuum systems for health care facilities.
D ' -' _ Fountain ❑ Any multipurpose fire sprinkler system.
El e Wash Any complex structure as defined in OAR918- 780-0040.
Floor Drain/sink - 2"
• 3" Submlta sets of plans with any of the above.
-4"
Car Wash etc, ;:=•.. . �:• x ..::..::..
-D Drain
Garbage r y.: ,: ■ ,,?:•• .
-Domestic-non-food • Isometric or ris 4 e .:............•:..:._ ': .,._. � _
_......�; s��.
riser ' s
Disposal - Domestic -food related diagram is required for new buildings
- Commercial -food related meet the uaiifications above.
-Industrial -food related
Ice Mach./Refri _ Drains
Oil S • orator Gas Station
Rec. Vehicle Dam •Station Comments regarding fixture work:
•
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimmin_ Pool Filter
washer - Clothes sewer II:DUs, a sewer * Note: If the fixture work under this permit results in an
Water Extractor h increase of
water Closet - Totter permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Urin Fixtures: plumbing permit can be issued.
http:/ /www.tigard•or, gov/ city_ hall/departments /cd/docs/PLMF- PermitApp2doc
. .. ; E D
�b
anical Permit ApplieatThn F()R ul Fic l" t ()N1.1
City of Tigard AUG 16 2012 Received ��`� A Permit No.:
DateBy: / FYI
• 13125 SW Hall Blvd., Tigard, OR 97223 .�.,/: Plan Review Other Permit: I / q • 1
Phone: 503.718.2439 Fax: 503.5 ur 1>N A R � Date/By:
Ins action Line: 503.639.4175 `(( �n DNISI Date Ready/By: Iurb: IS See Page 2 or
Internet: www.tigard- or.gov
I L. IL U p B u"'� Notified/Method: Supplemental Information
COM1 RCIAL I 3F Q - li llfariti tt
=' .' 'H :.:: =;: •;a';. ' : ":'` - Mechanical ermit fees* are based on the value of the work
g New construction ❑ Addition/alteration/replacement performed. permit
the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit
1 Demolition ❑Other: • Value: $
.,�"� • a 7�t��• 'v�x,;r` "1U7��,*.. -...� ,... _ ... ., .. .:a: RIr7$ID)� . -„ ... �.� n,:..
1 - and 2- family dwelling in Commercial /industrial ❑ Accessory building For spatial information use checklist
] Multi- family 0 Master builder ❑ Other: Description I Qty. I Ea. I Total
{ Heating/coolintt:
1'h' � r:-"A3 '' ! , .. - ....,. -_ - 7"4`:_"4''' Air cond itioning
.��.�uri��,. �t.. E. _ - �` ,, ,:. -,_... 46.75
10 .,
lob site address: 3 7 s (requires site plan showing placement) Furnace 100,000 BTU (ducts/vents) 1 46.75
-/- 4
City/State/ZIP: , 7 Z.2-t
Furnace 100,000+ BTU (ducts/veins) 54.91
5ttiteJbldgJapt no.: I Project name: (requires sitte plan showing placement) 61.06
Cross street/directions to job site: Duct t work 23.32
��// Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric), .
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: .. I Lot no.: /3 Other: • 23.32
Tax map /parcel no.: 251 O 2- iii C. ¢4 `e Other fuel appliances:
t ; y; :: ! =',.:, a Water heater 23.32
.= t�r - ,.i:?,.,,Fj� ,`e, t,a,; - : 33.39
;�'�i � :,, }' Gas fireplace insert
/- A ^-e- Flue vent for water heater or gas 32
r ` fire lace
Log lighter (gas) 23.32
• Wood/pellet stove 33.39
Wood fireplace/insert 23.32
rr u ;, r u r . .uw,a r
° •:�' ;i.': a o Chimney/liner /flue/vent 2332
ti -1 4 w ° ' 1 ll; , ^t4, AAl'I'e4Y T .r 23.32
i�� � a7 3 + ) , c � - O t h er.
T�;t., �2�.v � ... .rir1GT�� _1LY 7oG�
Name: 6. ,sic- C (46,L , Environmental exhaust and ventilation:
Range hood/other kitchen 1 33.39
Address: ! 9 20 YG a` •
equipment
• Clothes dryer exhaust 1 33.39
City/State/ZIP: • 6� f e 04-- Q L Single -duct exhaust (bathrooms,
Phone: (199 ) 6$2 -3 3 - 6 Fax: (5 )6.9 2- 51" 3 3 toilet compartments, utility rooms) 23
:v:• °;" L Attic/crawlspace fans I 2332
r, ;: a rr `` 23.32
:����.L,.,:� „•a,.�r L. � , , . _ Other.
Business name: / . , e0 .4 2..... 6,..,,,e- d << Fuel piping:
Contact name: A, ae..rt� S14.15 for first four, $4.03 for each additional
/ Furnace, etc. I
Address: ` 2.= S Y` Gas heat pump
City/State/ZIP: .141..4,J DA 1" 2 Z- WalVsuspended/unit heater
�
Phone: (5t )hqL3 / 0 I Fax: :(P3)4YZ W ater heater I - 5fe33
E -mail: •(.0 w1 (i ‘,... ° , eaw r Range
sa r^c� +vy.Nd �aa. Kx , , :,.:,•; • -- a;._ w ...• .•l r'
�� , . Barbecue
. ta�Z, +1 �'fi..^.kq��;1 - T.i Sa7161 � / n` dryer (gas)
GG g w " � - Clothes. er
Business name: 1/L (� � . C��; o f Other
Address: l 0 • t s. S Z l '8 ., " : , ,,
r••J4 'FS G S 2- Subtotal •
City/StatelZlP: V4 K ` p Minimum permit fee ($90.00)
Phone: (sow) L 5-s-- 6 ZZ( Fax: ( ) d 5e) Z9p3 Plan review (25% of permit fee)
CCB lic.:
yz S! State surcharge (12% of permit fee)
9 TOTAL PERMIT FEE
/ This permit application expires if a permit is not obtained within 180
Authorized signature: G days after it has been-accepted as completes
I Date: V/ sj f 7i 1 • Fee methodology set by Tri- County Building Industry Service Board
Print name: �' ._..._...__....,.....�.
• •
•
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information •
Commercial & Multi-Family Fee Schedule:
41; :•(] htO1tatAkii;:i?=5.
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
•
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
IN3uildineemtits1MEC-PermitApp.doc 03/07/12 2
lectrical Permit Application ,
• . City' of Tigard . 1 i ' • Received
Date/B : Permit No? ��
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' �_�" `
a Phone: 503.718.2439 Fax: 503.598.1960 '. 'j 5 7 - Date/B : Other Permit:
1 c;A R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard- or.gov : • Notified/Method: Supplemental Information
New construction ❑ Addition /alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Other Service or feeder 400 amps or more ❑ Building over three stOries.
I
Demolition
- e` ^ . -'1 - re a available m
fault current ❑Marinas and boaryar
'v - ' a ::=5'> . ?. :. ::,�, ': - exceeds 10,000 amps at 150 volts or ❑Floating buildings.
j 1 - and 2- family dwelling ❑ CommerCial/industrial less to ground, or exceeds 14,000 ❑ commercial -use agricultural ❑ Accessory building amps for all other installations. buildings.
Multi- family ❑ Master builder ❑ Other: ❑ Fire pump.
:; . d0B SPL'L system
•.....�..:. :._.,,... ono K
.:.. :• .. ..•. .t :.. �L� :: . .:; : : :.; :: load of Se elyderived
.. - : , ., ... = ❑Add t ge ncy sysre larger
' •"•- ''''' ` ❑ i io of new motor c o ❑ "A" '•E" "1 -2^ "1 -3 ",
o no.: Job site address: / 3 g 7 ' 5 f p 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
ty /State/ZIP: - 7 . ,\ . 4A. ! 7 2 2 li ❑ Health -care facilities. ❑ Supply voltage far mare than
❑ Hazardous locations. 600 volts nominal.
ite/bldg./apt. no.: I Project name:. ❑ Service or feeder 600 amps or more.
:,. :, :1 ;SCRED , : : -r :3 ti,,: .
oss street/directions to job site: Description . � �t
Description - I Qtr. I Pee. 1 Total 1
. New residential single- or multi - family dwelling unit.
Includes attached garage. -
bdivision: , .,,ra_ •t 4 Z I Lot no. 1,000 sq. ft or less I ( I 168.54 4
x map /parcel no.: Ea. add•I 500 sq. ft or portion
.. n 33.92 1 •
x , r _ :y,� ,,• Limited energy, residential
r rsi i:' ,._ ter; rw: = �n 8y 2
7
r'S'ti_ {. :. : #; - :-�, , . ,.. ,,,,; _`, •�.'�'- _,�= x. :_�,• : .... 75.00
"- 't e. r; �- ,� "75', :: .a : ;- , :;.;a,f : - (with above so. ft
/ Limited energy, multi - family
Ac 75.00 2
.. G residential (with above sq. ft) •
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 100.70 2
s :fi ,,.. -.:: ........... : ,�;.. :.�:•..es:: t :;� ^'�.,�: _ _ 201 amps to 400 am
: •.. _ - ... ... . _- ... .._ .. ... amps 133.56 2
me: G wiz-e2, _ (1 t 1.--e.. (.-.e 401 amps to 600 amps 200.34
601 amps to 1,000 amps 301.04 2 2 •
ld � • , ress: / Q Z t.J e { ' � . Over 1,000 amps or volt; 552.26 2
:y/State/ZIP: ^ p Q Z Temporary services or feeders installation, alteration, and/or
774..,.6.4...-6, O q relocation
one: (5 ) to 72. -3„.3 C l o Fax: (5 45) 6 v. - $1133 200 amps or less 1 59.36
made property 401 amps to 400 amps 125.08 2 "
veer installation: This installation is being pr perry that I own which is not 401 cps to 599 amps 168.54 2
ended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel -
mer signature: Date: A. Fee for branch circuin with
.F '�_ ;_ :r=" : :'.;� ' r =nits-' �a�e, p above service or feeder f
, ,.: • _. .. � _ .:... .:.:..: M..,�y: :,.5. ::.� 'y;�:, .;.�' ::� iea!•tMA"ar�`6a�T!: ..:- _ 2
each branch circuit
. • .,an'L • ... 'T.:`.:. ...., _ 7.42
siness name: G 44z`�C�4, j� ea 4.4_ B. Fee for branch circuits without
service or feeder fee, first 56.18 2
ntact name: /< A .3 G mol t- 2._ branch circuit
/ / Each add'I branch circuit 7.42 2
•dress: C f 2.41:1 2.41:1 d ` 4i6• Miscellaneous (service or feeder not induded)
y /S /Z P: � Each manufactured or modular
�' '� A �/ dwelling, service and/or fader 67.84 2
one: (5(3.3 ) 4 i2- 3 I I Fax: : (5d3) c/ z- s t L3 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
nail: vied
u? _ .
�� .. FN. lighting
,,,�, ` Sign or outline ligh 67.84
' `; -�tE++�si�•.��� .. li . i, . ..._...
. _.. ,,e ling qr `. Signal circuit(s)orlumted -energy I 2
.
sines name: R 1: 4A , f 6 G464.6 F �e I panel, alteration or extension Paget I 2
Each additional Inspection over allowable in any of the above
dress: Z b . 4611 SC-•J tiler e. 4q» • Additional inspection (1 hr min) j
66.23/ hr
.y /State/ZIP: . 5 - ; , , , „ d 64 11 0 e r . investigation (1 hr min) I 66.25/ hr
industrial plant (1 hr min) j 78.18/ hr
one: (SG3) g4 a - yZ cy Fax: (S43) 4•48_ I! r Inspections for which no fee is 90,00/ hr
s • - fica
ill listed %r hr min
;B Lic.: A if gZ I Electrical Lic.: CSS'S' Suprv. Lic.:yY33S r, :.:.t,. -. .... ..-__._ _,_., .. -.. : ate;:.. .
prv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
int name: /zou V ,' Date: Zs -/2 State surchargc(129'6 of permit fee):
TOTAL PERMIT FEE:
Ithorized signature: .
The permit application eapia'if a parsttr1s not ohaalraadwitids lie
Da te: -2S---(2_ da haadraao
inn name: • Numbs of i
ntpeanam'dlorrat ► tsar puma.
JdileiFartnibl®GPe+mitApp.doe 07/01110 440.4615T(1I/0S/COMIW118
..
Q ° Building Division
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: .&)i o, -oo at 7
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans:
Original Plan Submittal Date: 119 1
1st Revision Submittal Date: • ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (V) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact 7 ! f us r- at 503 -718- 2 (13 ' or � p @ti or.
Land Use Case No. 5 24 3 24 � °- I Name 6 W6-ecoo� /1 /
0' Zoning � L (.
12 Setbacks: _ _
Front 2- Rear 1" Side 5 Street Side NA" Garage 2-°
D Maximum Building Height - Actual Building Height 2-c/
.2 Visual Clearance
El Easements
❑ Sensitive Lands Type: /-%.)
Notes:
Original Plan: Approved Not Approved ❑ Date: ff `Z I` f -
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov)
Hr Actual Slope:
Notes:
Original Plan: Approved Not Approved ❑ Date: e (
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City borist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov)
S treet Trees
P rotected Trees
Notes:
Original Plan: Approved L'7 Not Approved ❑ Date: l �'
Pp �l
Revision 1: Approved ❑ Not Approved ❑ Date: .
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant: -
Revision 1: Date Sent to Applicant _
Revision 2: Date Sent to Ap licant
5
Oka T to Issue Permit: Yes ( ❑
/
Date Routed to Building: 2....f �/
11
.
Page
RECEIVED
51.25' • AUG 162012
Elev. 200
0 Elev. 195 CITY OF TIGARD
Storm Easement BUILDING DIVISION
° FD5 /8 "IRW/
Siltfence
YPC INSCRIBED
r Siltfen "DRINKWATER PLS 926"
5.00 1 6,002 SQFT7t •5.00
1
co 1 " 1 0
(N I Elev. ' 01.5 m
CV —
7 69 Elev. 203
Ii N
i;,74 I- Lc)
Elev. It CO 2035 ° 1`r) • •
co I 0-.) a — 0) 00
elf* to M
vV IIR! m
IIN - t! 3
_ , NI !fl of W z
N I
co
Elev. 203 .4 i i u _
ii FD 3/4" IP
I - . i -' '
C,
9 14 I 3 Grave' 'Qrive e< ) ,
o for Erosi 1, , � ¢, i
r, Se � e < 3 Elev. 203
,,,,,,___.../------ 1116.41fh 0% •Ci 0
Elev. 204 3o S 30'09'22" E
`� 18.80'
S �
ley. 21 •
S 41'12'02" E
22.85'
*1
ER 0 CONSTRUCTION
T COMPANY INC.
HOME SQUARE FOOTAGE '
MAIN FLOOR =1678 SQ.FT. BUILDING
UPPER FLOOR = 808 SQ. FT. CUSTOM HOMES SINCE 1977
Street trees Tilia
(503) 692 -3390 Ameranana 2"
TOTAL = 2486 SQ. FT. 13878 SW 90th
GARAGE = 421 SQ.FT. Lot 13 EDGEWOOD EAST
SCALE 1' = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 8/15/12
Nov 14 12 12:19p BRIGHTEN ELECTRIC 5415497213 p.1
Electrical Permit Application RECEIVE r FOR OFFICE tat. ONLY'
,
City of Tigard NOV 1 4 2012 Received 1�
: .. Permit Nu.
�
13125 SW Hall Blvd_, Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196CI'n/ Of T� e p n Other Pennit:
rr,]A1li/
TI V A R I) Inspection Line: 503.639.4175 Date Ready / By: Jw is ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/me"": Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w. items checked below):
El Service or louder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 antes at 150 sults or ❑ Floating buildings.
less to pound, or excels 14.000 ❑ Commercial-use agricultural
_al - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: Prim pwnp. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
['Addition of new motor load of ❑' A" "E' `I -2^ "t -3^
Job no.: Job site address: Q -J�/ -1-k IOOIIP or more. occupancy.
! �� Q ❑ Six or mere residential tools. ❑ Recreational vehicle parks.
City/State/ZIP. 1 1 ,�� 0 t y� ❑Health -care facilities ❑ Supply voltage for more than
`� ' ll 1 \ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder &00 amps or more.
FEE SCHEDULE
Cross strect/directions to job site:
Description [ on. I i.e. ' I Tonal ) •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 13 1,000 sq. n. or Itss 168.54 4
Ea. add'I 5■0 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy. residential
75.00 2
• DESCRIPTION OF WORK (with above sq. It, )
Limited energy, multi - family
75.00 2
N Pk f ! C la 0,_n -e e t -ect CU 1 residential (with above sq. fl.)
Services or feeders installation, alteration, and/or relocation
C (711 1( c+ 0 �' 200 amps or Its, l 00.70 2
G D PR OPERTY OVIN ER ❑ TENANT 201 unps to 400 amps 1 33.56 2
401 amps to 600 amps 200.34 2
Name. 601 amps to 1.001) amps 301.04 2
-
Address: Over 1,000 amps or volts 552.26 2 1 .
si
City/State/ZIP:
Temporal)' Nen•icec or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not
201 amps to 400 amps 1 25,08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits Irish
❑ APPLICANT 1 ❑CONTACT PERSON above setvitx or fix�cr fee. 7 42 2
each branch circuit
Business name: B. Fee for branch circuits triihr�du
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add' I branch cncuit 7.42 2
Address: Miscellaneous (service or feeder not included)
" Each manufactured or modular
a City /S[aze/ZlP: dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
c`
_ VI ( P hone: ( ) Fax: : ( )
1 Pump or irrigation circle 67.84 2
1 E -mail. I Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
mint
- Business name: 7 f Y1�1 C (eL -i -1 G ,LG pastel alteration, or extension. Page 2 2
_ h r ; Each additional inspection over allowable in any of the above
Address: 1• C 8o X 7 2:75 4,: c--
inspection (1 hr min) 6625 / hr
Investigation (I hr min) 66.25/ hr
City /State2lP: C 5-1--or 5 i O g 9-7 1 51 Industrial plant (1 hr min) 78.18/ hr
Phone: ( t 5 - f 1) S Fax:/( 4) ( 1243 Inspections for which no feu is
specifically - 7 2.4 7 r 5 � 1 - 1 �v fically listed (%r hr 90.00 / hr
CCB Lie.: / 3 3 2 f Electrical Lic.: 3:. t �if 3 U Suprv. Lic.: Lilo y , ELECTRICAL PERMIT FEES
iI /AO l� ` /7 e / ' ' r 5 Subtotal: I
Y
S uprv. Electrician signature, required: /o
Plan review (25% of permit it lee):
Print name: La 1('/'y (�i�✓1 Date: ////3//2- e: I State surcharge (12% of permit fee).
\ Gi
� . Authorized signature: ( I TOTAI. PERMIT I �F.:
i This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per prnmt.
t:utuil wamimttl.C•Pertaitnpp.doe 07/01/tS 440-4615T(I I/OS/COM/WE8